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Individual

GLEN L WESTOVER

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.C.

Contact information

Practice address
301 S DIVISION ST, PINEHURST, ID 83850-9767
(208) 682-2122
(208) 682-2825
Mailing address
301 S DIVISION ST, PINEHURST, ID 83850-9767
(208) 682-2122
(208) 682-2825

Taxonomy

Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
CHIA-347
ID

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000010139794
BLUE SHIELD
ID
01
C3555
BLUE CROSS
ID
Enumeration date
11/30/2006
Last updated
07/08/2007
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